“Do More with Less” is a timely topic. It’s often the first reaction I hear from AHA members, who say: “We’re scouring every opportunity to save dollars, but it’s not enough. How do we improve quality and patient safety in the face of deep cuts, shrinking coverage and expanded patient volumes? Is it even possible?”

My answer is yes. But I challenge hospital leaders to reframe their mindset. As we move to a fixed payment model and are at greater financial risk, perhaps the real question is, “How can we do less with less?”


Less Is More

Let me explain. Envision your hospital operating in the future world of fixed payments. In this world, doing less with less isn’t just a play on words — it’s the practice of keeping people healthy and cultivating a culture that requires less clinical intervention. But prevention isn’t a panacea. For particularly critical cases, hospitals will be doing whatever is needed to get upstream to prevent costly problems that might arise later.

Of course, when I talk about “doing less,” I don’t mean clinicians and administrators can look forward to large blocks of idle time. On the contrary, clinicians and administrators will still be “doing” plenty. But they’ll be doing less of what they’re doing today – delivering fewer interventions, spending less time on redundant processes, diverting less mental energy to cumbersome administrative tasks. In short, they’ll be working smarter, while achieving greater value.

When I discuss a shift toward working smarter, it gets people’s attention—because it makes good sense. Here’s an example of “doing more” vs. “doing less” as it applies to clinical intervention. Under the “doing more” model, you’re concerned about how you’ll care for even more poorly-insured patients who wind up on your ED doorstep. These patients will be an even greater burden on your overtaxed system.

Using the “doing less” approach, you’re less focused on downstream intervention, but more focused on proactively addressing population health. You’re hiring nursing staff to go into the community to keep people well and out of your ED. And you’re investing in health IT solutions to unite multiple physicians around coordinated care plans that eliminate duplicate testing, save labor costs, decrease lengths of stay and improve outcomes. In this equation, you’re consuming fewer resources, reducing interventions and achieving better outcomes.

And while you’re working to foster wellness outside your walls, you’re also looking inward to standardize processes and supplies, and to reduce the wide-ranging, unnecessary customization of both. You’re sharing data with physicians to illuminate variability in treatments and demonstrate the value of standardized practices. You’re looking across your multiple facilities to consolidate imaging and ancillary services, and you’re redeploying labor more efficiently.

Although our industry hasn’t fully transitioned from fee-for-service to the fixed payment model—and the challenges of doing so are many—forward-thinking hospital leaders are already allocating resources to successfully position their organizations for these inevitable changes.


In Turbulent Times, Control What You Can and Stay Flexible

Turbulent times demand both accountability and agility. As Colin Powell said, “No battle plan ever survives the first encounter with the enemy.” Accountability and flexibility are the orders of the day.

As Pat Blake mentions in his article in this issue, there are many external levers acting on the business of healthcare, but there are many powerful internal levers we can pull. These levers can give us a solid measure of control in the midst of seismic change. Key among them: aligning players (physicians, hospitals and providers), improving quality, and building integration into our systems.

As an underpinning to these strategies, information technology (IT) holds real promise. Examples:

  • Bar-code medication scanning. Not only does this technology facilitate the “five rights,” it can reduce the number of costly adverse events, decrease lengths of stay, improve staff productivity and shrink liability claims.
  • Electronic health records (EHRs). EHRs serve to coordinate care across settings, saving clinical time, decreasing duplication of services and reducing the need for administrative support.
  • Decision support solutions. These solutions help improve care delivery at the bedside, avoiding costly and time-consuming intervention downstream.

In short, IT is an important part of the equation – and along with changes in process and mindset, can help free our workforce to focus on wellness, prevention and collaboration. Over time, we can spend less time on traditionally reactive activities and concentrate more on proactive, progressive and efficient activities.


Wise Investing for Tomorrow’s Payoffs

We’re not there yet, but we can confidently expect a full future return on today’s investments in productivity and efficiency. And ultimately, we’ll be doing less with less – even as we accomplish more.


Organizations Use Benchmarking to Sharpen Their Operations

How do you know your department processes are optimized and firing on all cylinders? To truly know where your organization stands and where to focus your scare resources, you must compare your results for specific metrics against:

  • Industry best practices
  • Median performance at the national, state or regional level
  • Competitors
  • Facilities in your health system

Here are some examples of how organizations are using vendor-neutral benchmarking solutions to enable them to drill-down into their operations to optimize processes, reduce cost, improve efficiency and increase revenue.

  • One of the 400-members of the OR Benchmarks® Collaborative reduced its premium overtime hours by 25%. It also improved its management of block scheduling and increased on-time starts from 20% to nearly 75%. The OR Benchmarks Collaborative has been benchmarking OR practices for organizations of all sizes across the nation since 2007. De-identified data help organizations benchmark their operations for volume, turnover time, utilization by hour of day, efficiency, time accuracy and total case time, in addition to other key performance indicators.
  • The ED Benchmarks Collaborative™, a joint initiative developed by experts at McKesson in conjunction with the Emergency Nurses Association, offers subscribers 17 key performance indicators (KPIs) for the ED in three categories: throughput, productivity and quality. One member’s ED Director saw for the first time that their overall performance in determining triage acuity was skewed toward under-triaging patients with potentially high-risk situations. Using EDBC they were able to analyze the nurse triage performance and implement an education plan as needed.
  • Quality Benchmarks Collaborative™ captures clinical data at the point of care and compares results across caregivers, populations and time segments. The collaborative provides a baseline for health reform metrics by incorporating financial and operational dimensions of care. Members are using scorecards to identify and resolve workflow barriers to attesting to Stage 1 Meaningful Use. Just two examples are workflows for registration of patients admitted from the ED and documentation of vital signs. The ability to identify errors in these processes, which contribute to false metric reporting, enables organizations to optimize performance, enable quality outcomes, and support regulatory compliance and stimulus incentive fund efforts.

With credible data for benchmarking performance against other organizations, the process of reengineering becomes easier. It helps break down the resistance to change by showing what is working in other organizations. Stakeholders can access root causes, identify opportunities for change, and then set standards that are comparable to similar organizations. The true value of benchmarking lies in its ability to promote continuous improvement within a healthcare organization.

Richard Umbdenstock

About the author

Richard Umbdenstock became president and CEO of the American Hospital Association (AHA) in 2007. Previously, he was the elected AHA Board Chair in 2006. Mr. Umbdenstock’s career includes experience in hospital administration; health system governance, management and integration; association governance and management; HMO governance; and health care governance consulting. He has written several books and articles for the health care board audience and has authored national survey reports for the AHA and its Health Research and Educational Trust and for the American College of Healthcare Executives. Mr. Umbdenstock serves on the boards of the National Quality Forum and Enroll America, and co-chairs the CAQH Provider Council. He also serves on the National Priorities Partnership and on the Center for Transforming Advanced Care Steering Committee.